Provider Demographics
NPI:1396281283
Name:ATTIPOE, KIRSTEN
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:ATTIPOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 W OCEAN DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-4379
Mailing Address - Country:US
Mailing Address - Phone:919-521-0584
Mailing Address - Fax:
Practice Address - Street 1:765 NORTHUMBERLAND HWY
Practice Address - Street 2:
Practice Address - City:CALLAO
Practice Address - State:VA
Practice Address - Zip Code:22435-2206
Practice Address - Country:US
Practice Address - Phone:804-529-5178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist